Dennis Demetrius Williams, MA,ATC,LAT,PES,CES

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0604 Issued in NC

Practice address

1179 Madison Green Dr
Fort Mill, SC 29715

Phone

(864) 525-8821

NPI assigned

May 23, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1841728755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 MADISON GREEN DR",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297158321",
            "telephone_number": "864-525-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 MADISON GREEN DR",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "29715",
            "telephone_number": "864-525-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DENNIS",
        "middle_name": "DEMETRIUS",
        "name_prefix": "Mr.",
        "credential": "MA,ATC,LAT,PES,CES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-23",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "0604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPORTS MEDICINE",
            "identifier": "207PS0010X",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wholistic Advantage
• Matthew Wiggins, LPCA
• Tinashia Wilkins
• Mellissa Willette, BSN, IBCLC
• William S. Burns, D.M.D, P.a.
• Jennifer Paige Williams, MD
• Justice Williams, RBT
• Margaret Williams
• Scottie L. Williams, D.C.
• Kelly Taylor Williamson, FNP

• Athletic Trainer in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Athletic Trainer in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.